Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104001133 | VA |
NPI | 1124103700 |
---|---|
Provider Name | Dr. Nick Schapowal |
First Address | Chesapeake, VA 23320-1514 |
Second Address | Chesapeake, VA 23320-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
091612 | BC/BS PROVIDER # (01) | VA |